Provider Demographics
NPI:1447360003
Name:STORIE, DAVID J (DMD, MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:STORIE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SUNSET DR BLDG E # 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3033
Mailing Address - Country:US
Mailing Address - Phone:423-282-2333
Mailing Address - Fax:423-282-9337
Practice Address - Street 1:801 SUNSET DR BLDG E # 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3033
Practice Address - Country:US
Practice Address - Phone:423-282-2333
Practice Address - Fax:423-282-9337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics